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Liang Y, Zhao Q, Neubert JK, Ding M. Causal interactions in brain networks predict pain levels in trigeminal neuralgia. Brain Res Bull 2024; 211:110947. [PMID: 38614409 DOI: 10.1016/j.brainresbull.2024.110947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 03/13/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
Trigeminal neuralgia (TN) is a highly debilitating facial pain condition. Magnetic resonance imaging (MRI) is the main method for generating insights into the central mechanisms of TN pain in humans. Studies have found both structural and functional abnormalities in various brain structures in TN patients as compared with healthy controls. Whereas studies have also examined aberrations in brain networks in TN, no studies have to date investigated causal interactions in these brain networks and related these causal interactions to the levels of TN pain. We recorded fMRI data from 39 TN patients who either rested comfortably in the scanner during the resting state session or tracked their pain levels during the pain tracking session. Applying Granger causality to analyze the data and requiring consistent findings across the two scanning sessions, we found 5 causal interactions, including: (1) Thalamus → dACC, (2) Caudate → Inferior temporal gyrus, (3) Precentral gyrus → Inferior temporal gyrus, (4) Supramarginal gyrus → Inferior temporal gyrus, and (5) Bankssts → Inferior temporal gyrus, that were consistently associated with the levels of pain experienced by the patients. Utilizing these 5 causal interactions as predictor variables and the pain score as the predicted variable in a linear multiple regression model, we found that in both pain tracking and resting state sessions, the model was able to explain ∼36 % of the variance in pain levels, and importantly, the model trained on the 5 causal interaction values from one session was able to predict pain levels using the 5 causal interaction values from the other session, thereby cross-validating the models. These results, obtained by applying novel analytical methods to neuroimaging data, provide important insights into the pathophysiology of TN and could inform future studies aimed at developing innovative therapies for treating TN.
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Affiliation(s)
- Yun Liang
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Qing Zhao
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - John K Neubert
- Department of Orthodontics, University of Florida, Gainesville, FL, United States
| | - Mingzhou Ding
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States.
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Tilbor E, Hadar A, Portnoy V, Ganor O, Braw Y, Amital H, Ablin J, Dror C, Bloch Y, Nitzan U. TMS in combination with a pain directed intervention for the treatment of fibromyalgia - A randomized, double-blind, sham-controlled trial. J Psychiatr Res 2024; 170:167-173. [PMID: 38150768 DOI: 10.1016/j.jpsychires.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 12/03/2023] [Accepted: 12/10/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Fibromyalgia Syndrome (FMS) is a highly prevalent condition, that causes chronic pain and severe reduction in quality of life and productivity, as well as social isolation. Despite the significant morbidity and economic burden of FMS, current treatments are scarce. OBJECTIVE To investigate whether stimulation of ACC -mPFC activity by dTMS enhances a pain-directed psychotherapeutic intervention. METHODS 19 FMS patients were randomised to receive either 20 sessions of dTMS or sham stimulation, each followed by a pain-directed psychotherapeutic intervention. With the H7 HAC coil or sham stimulation, we targeted the ACC -mPFC; specific brain areas that play a central role in pain processing. Clinical response to treatment was assessed with the McGill Pain Questionnaire Short Form (SF-MPQ), the Visual Analogue Fibromyalgia Impact Questionnaire, the Brief Pain Inventory questionnaire, and the Hamilton Depression Rating Scale. RESULTS DTMS treatment was safe and well tolerated by FMS patients. A significant decrease in the combined sensory and affective pain dimensions was specifically demonstrated in the dTMS cohort, as measured by the SF-MPQ (Significant group × time interaction [F(2, 32) = 3.51, p < .05,ηp2 = 0.18]; No significant changes were found in depressive symptoms in both the dTMS and sham groups. CONCLUSION Our results suggest that a course of dTMS combined with a pain-directed psychotherapeutic intervention can alleviate pain symptoms in FMS patients. Beyond clinical possibilities, future studies are needed to substantiate the innovative hypothesis that it is not dTMS alone, but rather dTMS-induced plasticity of pain-related networks, that enables the efficacy of pain-directed psychotherapeutic interventions.
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Affiliation(s)
- Einat Tilbor
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Aviad Hadar
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Victor Portnoy
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel.
| | - Ori Ganor
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Yoram Braw
- Ariel University, Department of Psychology, 65 Ramat HaGolan Street, Ari'el, Israel.
| | - Howard Amital
- Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel; Sheba Medical Center Hospital, Tel Hashomer, 52621, Ramat Gan, Israel.
| | - Jacob Ablin
- Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel; Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 6423906, Israel.
| | - Chen Dror
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Yuval Bloch
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
| | - Uri Nitzan
- Shalvata Mental Health Center, 13th Aliyat- Hanoar Street, Hod Hasharon, Israel; Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
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Sacca V, Wen Y, Hodges S, Kong J. Modulation effects of repeated transcranial direct current stimulation on the dorsal attention and frontal parietal networks and its association with placebo and nocebo effects. Neuroimage 2023; 284:120433. [PMID: 37939891 PMCID: PMC10768876 DOI: 10.1016/j.neuroimage.2023.120433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/01/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023] Open
Abstract
Literature suggests that attention is a critical cognitive process for pain perception and modulation and may play an important role in placebo and nocebo effects. Here, we investigated how repeated transcranial direct current stimulation (tDCS) applied at the dorsolateral prefrontal cortex (DLPFC) for three consecutive days can modulate the brain functional connectivity (FC) of two networks involved in cognitive control: the frontoparietal network (FPN) and dorsal attention network (DAN), and its association with placebo and nocebo effects. 81 healthy subjects were randomized to three groups: anodal, cathodal, and sham tDCS. Resting state fMRI scans were acquired pre- and post- tDCS on the first and third day of tDCS. An Independent Component Analysis (ICA) was performed to identify the FPN and DAN. ANCOVA was applied for group analysis. Compared to sham tDCS, 1) both cathodal and anodal tDCS increased the FC between the DAN and right parietal operculum; cathodal tDCS also increased the FC between the DAN and right postcentral gyrus; 2) anodal tDCS led to an increased FC between the FPN and right parietal operculum, while cathodal tDCS was associated with increased FC between the FPN and left superior parietal lobule/precuneus; 3) the FC increase between the DAN and right parietal operculum was significantly correlated to the placebo analgesia effect in the cathodal group. Our findings suggest that both repeated cathodal and anodal tDCS could modulate the FC of two important cognitive brain networks (DAN and FPN), which may modulate placebo / nocebo effects.
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Affiliation(s)
- Valeria Sacca
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Ya Wen
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Sierra Hodges
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA.
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Pereira AR, Alemi M, Cerqueira-Nunes M, Monteiro C, Galhardo V, Cardoso-Cruz H. Dynamics of Lateral Habenula-Ventral Tegmental Area Microcircuit on Pain-Related Cognitive Dysfunctions. Neurol Int 2023; 15:1303-1319. [PMID: 37987455 PMCID: PMC10660716 DOI: 10.3390/neurolint15040082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
Chronic pain is a health problem that affects the ability to work and perform other activities, and it generally worsens over time. Understanding the complex pain interaction with brain circuits could help predict which patients are at risk of developing central dysfunctions. Increasing evidence from preclinical and clinical studies suggests that aberrant activity of the lateral habenula (LHb) is associated with depressive symptoms characterized by excessive negative focus, leading to high-level cognitive dysfunctions. The primary output region of the LHb is the ventral tegmental area (VTA), through a bidirectional connection. Recently, there has been growing interest in the complex interactions between the LHb and VTA, particularly regarding their crucial roles in behavior regulation and their potential involvement in the pathological impact of chronic pain on cognitive functions. In this review, we briefly discuss the structural and functional roles of the LHb-VTA microcircuit and their impact on cognition and mood disorders in order to support future studies addressing brain plasticity during chronic pain conditions.
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Affiliation(s)
- Ana Raquel Pereira
- Instituto de Investigação e Inovação em Saúde—Pain Neurobiology Group, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal; (A.R.P.); (M.A.); (M.C.-N.); (C.M.); (V.G.)
- Instituto de Biologia Molecular e Celular, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Departamento de Biomedicina—Unidade de Biologia Experimental, Faculdade de Medicina, Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
| | - Mobina Alemi
- Instituto de Investigação e Inovação em Saúde—Pain Neurobiology Group, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal; (A.R.P.); (M.A.); (M.C.-N.); (C.M.); (V.G.)
- Instituto de Biologia Molecular e Celular, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Departamento de Biomedicina—Unidade de Biologia Experimental, Faculdade de Medicina, Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
| | - Mariana Cerqueira-Nunes
- Instituto de Investigação e Inovação em Saúde—Pain Neurobiology Group, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal; (A.R.P.); (M.A.); (M.C.-N.); (C.M.); (V.G.)
- Instituto de Biologia Molecular e Celular, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Departamento de Biomedicina—Unidade de Biologia Experimental, Faculdade de Medicina, Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- Programa Doutoral em Neurociências, Faculdade de Medicina, Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
| | - Clara Monteiro
- Instituto de Investigação e Inovação em Saúde—Pain Neurobiology Group, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal; (A.R.P.); (M.A.); (M.C.-N.); (C.M.); (V.G.)
- Instituto de Biologia Molecular e Celular, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Departamento de Biomedicina—Unidade de Biologia Experimental, Faculdade de Medicina, Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
| | - Vasco Galhardo
- Instituto de Investigação e Inovação em Saúde—Pain Neurobiology Group, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal; (A.R.P.); (M.A.); (M.C.-N.); (C.M.); (V.G.)
- Instituto de Biologia Molecular e Celular, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Departamento de Biomedicina—Unidade de Biologia Experimental, Faculdade de Medicina, Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
| | - Helder Cardoso-Cruz
- Instituto de Investigação e Inovação em Saúde—Pain Neurobiology Group, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal; (A.R.P.); (M.A.); (M.C.-N.); (C.M.); (V.G.)
- Instituto de Biologia Molecular e Celular, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Departamento de Biomedicina—Unidade de Biologia Experimental, Faculdade de Medicina, Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
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5
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Shaikh A, Li YQ, Lu J. Perspectives on pain in Down syndrome. Med Res Rev 2023; 43:1411-1437. [PMID: 36924439 DOI: 10.1002/med.21954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 01/08/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
Down syndrome (DS) or trisomy 21 is a genetic condition often accompanied by chronic pain caused by congenital abnormalities and/or conditions, such as osteoarthritis, recurrent infections, and leukemia. Although DS patients are more susceptible to chronic pain as compared to the general population, the pain experience in these individuals may vary, attributed to the heterogenous structural and functional differences in the central nervous system, which might result in abnormal pain sensory information transduction, transmission, modulation, and perception. We tried to elaborate on some key questions and possible explanations in this review. Further clarification of the mechanisms underlying such abnormal conditions induced by the structural and functional differences is needed to help pain management in DS patients.
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Affiliation(s)
- Ammara Shaikh
- Department of Human Anatomy, College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning Province, China
| | - Yun-Qing Li
- Department of Anatomy, Histology, and Embryology & K. K. Leung Brain Research Centre, The Fourth Military Medical University, Xi'an, Shaanxi Province, China
- Department of Anatomy, Basic Medical College, Zhengzhou University, Zhengzhou, China
| | - Jie Lu
- Department of Human Anatomy, College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning Province, China
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Yang J, Zeng WX, Cheng J, Kang M, Liao XL, Ying P, Ling Q, Zou J, Wei H, Wang YX, Su T, Shao Y. Fractional amplitude of low-frequency fluctuation changes of specific cerebral regions in patients with toothache: A functional magnetic resonance imaging study. Brain Behav 2023; 13:e2937. [PMID: 36934446 PMCID: PMC10097157 DOI: 10.1002/brb3.2937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/28/2023] [Accepted: 02/14/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Previous studies have indicated that pain-related diseases can result in significant functional alterations in the brain. However, differences in spontaneous brain activity in toothache (TA) patients remain unclear. OBJECTIVE To investigate altered spontaneous brain activity in patients with TA and its underlying mechanisms using the resting-state functional magnetic resonance imaging-fractional amplitude of low-frequency fluctuation (rsfMRI-fALFF) technique. METHODS Twelve patients with TA and 12 non-toothache controls (NTCs) (matched for sex, age, and level of education) were enrolled. Spontaneous cerebral activity variations were investigated using the rsfMRI-fALFF technique in all individuals. The mean fALFF values of the TA patients and NTCs were classified using receiver operating characteristic (ROC) curves. The correlations between fALFF signals of distinct brain regions and clinical manifestations of TA patients were evaluated using Pearson's correlation analysis. RESULTS TA patients showed lower fALFF values in the left superior frontal gyrus, medial; right superior frontal gyrus, dorsolateral; and left median cingulate and paracingulate gyri (LDCG) than the NTCs. Moreover, ROC curve analysis indicated that the area under the curve of each cerebral region studied had high accuracy. Besides, in the TA group, the visual analog scale score was negatively correlated with fALFF signal values of the LDCG (r = .962, p < .001). CONCLUSION Abnormal spontaneous activity was detected in numerous brain regions in patients with TA, which may be valuable for understanding the brain processing mechanism underlying TA. These regional changes in brain activity may serve as effective clinical indicators of TA.
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Affiliation(s)
- Jun Yang
- The Affiliated Stomatological Hospital of Nanchang University, The Key Laboratory of Oral Biomedicine, Nanchang, China
| | - Wan-Xin Zeng
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, China
| | - Jun Cheng
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, China
| | - Min Kang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, China
| | - Xu-Lin Liao
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Ping Ying
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, China
| | - Qian Ling
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, China
| | - Jie Zou
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, China
| | - Hong Wei
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, China
| | - Yi-Xin Wang
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Ting Su
- School of optometry and vision science, Cardiff University, Cardiff, UK
| | - Yi Shao
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Pujol J, Martínez-Vilavella G, Gallart L, Blanco-Hinojo L, Pacreu S, Bonhomme V, Deus J, Pérez-Sola V, Gambús PL, Fernández-Candil J. Effects of remifentanil on brain responses to noxious stimuli during deep propofol sedation. Br J Anaesth 2023; 130:e330-e338. [PMID: 35973838 DOI: 10.1016/j.bja.2022.06.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/24/2022] [Accepted: 06/19/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The safety of anaesthesia has improved as a result of better control of anaesthetic depth. However, conventional monitoring does not inform on the nature of nociceptive processes during unconsciousness. A means of inferring the quality of potentially painful experiences could derive from analysis of brain activity using neuroimaging. We have evaluated the dose effects of remifentanil on brain response to noxious stimuli during deep sedation and spontaneous breathing. METHODS Optimal data were obtained in 26 healthy subjects. Pressure stimulation that proved to be moderately painful before the experiment was applied to the thumbnail. Functional MRI was acquired in 4-min periods at low (0.5 ng ml-1), medium (1 ng ml-1), and high (1.5 ng ml-1) target plasma concentrations of remifentanil at a stable background infusion of propofol adjusted to induce a state of light unconsciousness. RESULTS At low remifentanil doses, we observed partial activation in brain areas processing sensory-discriminative and emotional-affective aspects of pain. At medium doses, relevant changes were identified in structures highly sensitive to general brain arousal, including the brainstem, cerebellum, thalamus, auditory and visual cortices, and the frontal lobe. At high doses, no significant activation was observed. CONCLUSIONS The response to moderately intense focal pressure in pain-related brain networks is effectively eliminated with safe remifentanil doses. However, the safety margin in deep sedation-analgesia would be narrowed in minimising not only nociceptive responses, but also arousal-related biological stress.
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Affiliation(s)
- Jesus Pujol
- MRI Research Unit, Department of Radiology, Hospital Del Mar, Barcelona, Spain; Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain.
| | | | - Lluís Gallart
- Department of Anesthesiology, Hospital Del Mar-IMIM, Barcelona, Spain; Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Blanco-Hinojo
- MRI Research Unit, Department of Radiology, Hospital Del Mar, Barcelona, Spain; Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain
| | - Susana Pacreu
- Department of Anesthesiology, Hospital Del Mar-IMIM, Barcelona, Spain
| | - Vincent Bonhomme
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium; Anesthesia and Intensive Care Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
| | - Joan Deus
- MRI Research Unit, Department of Radiology, Hospital Del Mar, Barcelona, Spain; Department of Psychobiology and Methodology in Health Sciences, Autonomous University of Barcelona, Barcelona, Spain
| | - Víctor Pérez-Sola
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain; Institute of Neuropsychiatry and Addictions, Hospital Del Mar- IMIM, Pompeu I Fabra University, Barcelona, Spain
| | - Pedro L Gambús
- Systems Pharmacology Effect Control & Modeling Research Group, Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
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Liu LY, Li X, Tian ZL, Zhang Q, Shen ZF, Wei W, Guo XL, Chen L, Su MH, Yang L, Yu SY, Yang J. Acupuncture modulates the frequency-specific functional connectivity density in primary dysmenorrhea. Front Neurosci 2022; 16:917721. [PMID: 36051643 PMCID: PMC9426343 DOI: 10.3389/fnins.2022.917721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe study aimed to investigate how acupuncture modulates brain activities across multiple frequency bands to achieve therapeutic effects in PDM.MethodsA total of 47 patients with PDM were randomly assigned to the verum acupuncture group and sham acupuncture group with three menstrual cycles of the acupuncture course. The fMRI scans, visual analog scale (VAS) scores, and other clinical evaluations were assessed at baseline and after three menstrual-cycles treatments. The global functional connectivity density (gFCD) analyses were performed between the pre-and post-acupuncture course of two groups at full-low frequency band, Slow-3 band, Slow-4 band, and Slow-5 band.ResultsAfter the acupuncture treatments, the patients with PDM in the verum acupuncture group showed significantly decreased VAS scores (p < 0.05). The frequency-dependent gFCD alternations were found in the verum acupuncture group, altered regions including DLPFC, somatosensory cortex, anterior cingulate cortex (ACC), middle cingulate cortex (MCC), precuneus, hippocampus, and insula. The sham acupuncture modulated regions including angular gyrus, inferior frontal gyrus, and hippocampus. The gFCD alternation in DLPFC at the Slow-5 band was negatively in the patients with PDM following verum acupuncture, and S2 at the Slow-4 band was positively correlated with VAS scores.ConclusionThese findings supported that verum acupuncture could effectively modulate frequency-dependent gFCD in PDM by influencing abnormal DLPFC at Slow-5 band and hippocampus at the Slow-3 band. The outcome of this study may shed light on enhancing the potency of acupuncture in clinical practice.
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Affiliation(s)
- Li-Ying Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiang Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zi-Lei Tian
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qi Zhang
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Zhi-Fu Shen
- Department of Traditional Chinese and Western Medicine, North Sichuan Medical College, Nanchong, China
| | - Wei Wei
- Chengdu Xinan Gynecological Hospital, Chengdu, China
| | - Xiao-Li Guo
- Chengdu Xinan Gynecological Hospital, Chengdu, China
| | - Ling Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Meng-Hua Su
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lu Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Si-Yi Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Si-Yi Yu,
| | - Jie Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu Xinan Gynecological Hospital, Chengdu, China
- Jie Yang,
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9
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Miseré RML, Rutten S, van den Hurk J, Colaris MJL, van der Hulst RRWJ. Neuroimaging in Breast Implant Illness: An fMRI Pilot Study. Aesthet Surg J 2022; 43:51-61. [PMID: 35926836 PMCID: PMC9830978 DOI: 10.1093/asj/sjac216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Some women with breast implants report systemic and cognitive symptoms known as breast implant illness (BII), which are very similar to those of fibromyalgia. Functional MRI (fMRI) has shown altered brain activity in fibromyalgia patients. OBJECTIVES The aim of this pilot study was to investigate whether brain alterations could be observed in BII patients by fMRI. METHODS Women aged 18 to 76 with silicone breast implants for cosmetic reasons were recruited through a Dutch online BII support organization (MKS) and through the Maastricht University Medical Center. Study participants comprised 12 women with BII and 12 women without symptoms. Participants completed questionnaires regarding demographic characteristics, medical history, psychosocial complaints (Four-Dimensional Symptom Questionnaire), cognitive failure (Mini-Mental State Examination), and pain intensity and pain-related disability (Chronic Pain Grade Scale). Subsequently, brain images of all participants were obtained by resting-state fMRI and diffusion tensor imaging in a 3-T MRI scanner (Siemens Medical System, Erlangen, Germany). RESULTS Eleven BII patients and 12 healthy controls were included in the analysis. Baseline characteristics were similar in the 2 groups and the mean silicone exposure was 15 years. Patients scored significantly higher than controls on both pain intensity and disability. Patients scored worse on depression, somatization, distress, and anxiety compared with asymptomatic women. Mini-Mental State Examination scores were normal. However, the analyses of both functional connectivity and structural integrity showed no significant differences between the 2 groups. CONCLUSIONS This pilot study showed no evidence of brain alterations in BII patients. However, patients scored significantly worse on psychosocial symptoms than controls. Psychological factors appear to play an important role in BII and should be further investigated. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Renée M L Miseré
- Corresponding Author:Dr Renée Miseré, Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
| | - Sanne Rutten
- Scannexus Ultra-high Field MRI Center, Maastricht, the Netherlands
| | - Job van den Hurk
- Scannexus Ultra-high Field MRI Center, Maastricht, the Netherlands
| | - Maartje J L Colaris
- Department of Plastic Surgery, Hand and Burn Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
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10
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Fernandez-Iriondo I, Jimenez-Marin A, Sierra B, Aginako N, Bonifazi P, Cortes JM. Brain Mapping of Behavioral Domains Using Multi-Scale Networks and Canonical Correlation Analysis. Front Neurosci 2022; 16:889725. [PMID: 35801180 PMCID: PMC9255673 DOI: 10.3389/fnins.2022.889725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Simultaneous mapping of multiple behavioral domains into brain networks remains a major challenge. Here, we shed some light on this problem by employing a combination of machine learning, structural and functional brain networks at different spatial resolutions (also known as scales), together with performance scores across multiple neurobehavioral domains, including sensation, motor skills, and cognition. Provided by the Human Connectome Project, we make use of three cohorts: 640 participants for model training, 160 subjects for validation, and 200 subjects for model performance testing thus enhancing prediction generalization. Our modeling consists of two main stages, namely dimensionality reduction in brain network features at multiple scales, followed by canonical correlation analysis, which determines an optimal linear combination of connectivity features to predict multiple behavioral performance scores. To assess the differences in the predictive power of each modality, we separately applied three different strategies: structural unimodal, functional unimodal, and multimodal, that is, structural in combination with functional features of the brain network. Our results show that the multimodal association outperforms any of the unimodal analyses. Then, to answer which human brain structures were most involved in predicting multiple behavioral scores, we simulated different synthetic scenarios in which in each case we completely deleted a brain structure or a complete resting state network, and recalculated performance in its absence. In deletions, we found critical structures to affect performance when predicting single behavioral domains, but this occurred in a lesser manner for prediction of multi-domain behavior. Overall, our results confirm that although there are synergistic contributions between brain structure and function that enhance behavioral prediction, brain networks may also be mutually redundant in predicting multidomain behavior, such that even after deletion of a structure, the connectivity of the others can compensate for its lack in predicting behavior.
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Affiliation(s)
- Izaro Fernandez-Iriondo
- Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), San Sebastian, Spain
- Computational Neuroimaging Lab, BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
- Doctoral Programme in Informatics Engineering, University of the Basque Country (UPV/EHU), San Sebastian, Spain
| | - Antonio Jimenez-Marin
- Computational Neuroimaging Lab, BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
- Biomedical Research Doctorate Program, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Basilio Sierra
- Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), San Sebastian, Spain
| | - Naiara Aginako
- Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), San Sebastian, Spain
| | - Paolo Bonifazi
- Computational Neuroimaging Lab, BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
- IKERBASQUE: The Basque Foundation for Science, Bilbao, Spain
| | - Jesus M. Cortes
- Computational Neuroimaging Lab, BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
- IKERBASQUE: The Basque Foundation for Science, Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), Leioa, Spain
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11
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Ma L, Liu S, Yi M, Wan Y. Spontaneous pain as a challenge of research and management in chronic pain. MEDICAL REVIEW (BERLIN, GERMANY) 2022; 2:308-319. [PMID: 37724190 PMCID: PMC10388751 DOI: 10.1515/mr-2022-0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/31/2022] [Indexed: 09/20/2023]
Abstract
Spontaneous pain occurring without apparent external stimuli, is a significant complaint of individuals with chronic pain whose mechanisms, somewhat surprisingly, remain poorly understood. Over the past decades, neuroimaging studies start to reveal brain activities accompanying spontaneous pain. Meanwhile, a variety of animal models and behavioral tests have been established, including non-reflexive tests and free-choice tests, which have been shown to be effective in assessing spontaneous pain. For the spontaneous pain mechanisms, multiple lines of research mainly focus on three aspects: (1) sensitization of peripheral nociceptor receptors and ion channels, (2) spontaneous neuronal firing and abnormal activity patterns at the dorsal root ganglion and spinal cord level, (3) functional and structural alterations in the brain, particularly the limbic system and the medial pain pathway. Despite accumulating evidence revealing distinct neuronal mechanisms from evoked pain, we are still far from full understanding of spontaneous pain, leaving a big gap between bench and bedside for chronic pain treatment. A better understanding of the neural processes in chronic pain, with specific linkage as to which anatomical structures and molecules related to spontaneous pain perception and comorbidities, will greatly improve our ability to develop novel therapeutics.
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Affiliation(s)
- Longyu Ma
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Shuting Liu
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Ming Yi
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing, China
| | - You Wan
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing, China
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12
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Zolezzi DM, Alonso-Valerdi LM, Ibarra-Zarate DI. Chronic neuropathic pain is more than a perception: Systems and methods for an integral characterization. Neurosci Biobehav Rev 2022; 136:104599. [PMID: 35271915 DOI: 10.1016/j.neubiorev.2022.104599] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
The management of chronic neuropathic pain remains a challenge, because pain is subjective, and measuring it objectively is usually out of question. However, neuropathic pain is also a signal provided by maladaptive neuronal activity. Thus, the integral management of chronic neuropathic pain should not only rely on the subjective perception of the patient, but also on objective data that measures the evolution of neuronal activity. We will discuss different objective and subjective methods for the characterization of neuropathic pain. Additionally, the gaps and proposals for an integral management of chronic neuropathic pain will also be discussed. The current management that relies mostly on subjective measures has not been sufficient, therefore, this has hindered advances in pain management and clinical trials. If an integral characterization is achieved, clinical management and stratification for clinical trials could be based on both questionnaires and neuronal activity. Appropriate characterization may lead to an increased effectiveness for new therapies, and a better quality of life for neuropathic pain sufferers.
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Affiliation(s)
- Daniela M Zolezzi
- Escuela de Ingeniería y Ciencias, Tecnológico de Monterrey, Monterrey 64849, Nuevo León, México; Center for Neuroplasticity and Pain, Department of Health Science and Technology, Aalborg University, Aalborg 9220, Denmark.
| | | | - David I Ibarra-Zarate
- Escuela de Ingeniería y Ciencias, Tecnológico de Monterrey, Puebla 72453, Puebla, México
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13
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Yuan I, Nelson O, Barr GA, Zhang B, Topjian AA, DiMaggio TJ, Lang SS, Christ LA, Izzetoglu K, Greco CC, Kurth CD, Ganesh A. Functional near-infrared spectroscopy to assess pain in neonatal circumcisions. Paediatr Anaesth 2022; 32:404-412. [PMID: 34747096 DOI: 10.1111/pan.14326] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pain assessment is challenging in neonates. Behavioral and physiological pain scales do not assess neocortical nociception, essential to pain encoding and central pain pathway development. Functional near-infrared spectroscopy (fNIRS) can assess neocortical activation to noxious stimuli from changes in oxy-(HbO) and total-hemoglobin concentrations (HbT). This study aims to assess fNIRS nociceptive functional activation in the prefrontal cortex of neonates undergoing circumcision through changes in HbO and HbT, and the correlation between changes in fNIRS and Neonatal Infant Pain Scale (NIPS), a behavioral pain assessment scale. METHODS In healthy term neonates, HbO, HbT, and NIPS were recorded during sequential circumcision events 1-Prep before local anesthetic injection; 2-Local anesthetic injection; 3-Prep before incision; 4-Oral sucrose; 5-Incision; 6-Gomco (hemostatic device) attached; 7-Gomco twisted on; and 8-Gomco removed. fNIRS and NIPS changes after each event were assessed with Wilcoxon signed-rank test and summarized as median and interquartile range (IQR). Changes in fNIRS vs. NIPS were correlated with Spearman coefficient. RESULTS In 31 neonates fNIRS increased (median [IQR] µmol/L) with noxious events: Local injection (HbO: 1.1 [0.5, 3.1], p < .001; HbT: 2.3 [0.2, 7.6], p < .001), Gomco attached (HbO: 0.7 [0.1, 1.7], p = .002; HbT: 0.7 [-0.2, 2.9], p = .02), and Gomco twisted on (HbO: 0.5 [-0.2, 1.7], p = .03; HbT: 0.8 [-0.1, 3.3], p = .02). fNIRS decreased with non-noxious event: Prep before incision (HbO: -0.6 [-1.2, -0.2] p < .001; HbT: -1 [-1.8, -0.4], p < .001). Local anesthetic attenuated fNIRS increases to subsequent sharp stimuli. NIPS increased with subsequent sharp stimuli despite local anesthetic. Although fNIRS and NIPS changed in the same direction, there was not a strong correlation between them. CONCLUSIONS During neonatal circumcision, changes in fNIRS differed between different types of painful stimuli, which was not the case for NIPS, suggesting that fNIRS may complement NIPS to assess the quality of pain.
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Affiliation(s)
- Ian Yuan
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Olivia Nelson
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gordon A Barr
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bingqing Zhang
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexis A Topjian
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Theresa J DiMaggio
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shih-Shan Lang
- Division of Neurosurgery, Department of Neurosurgery, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lori A Christ
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kurtulus Izzetoglu
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Christine C Greco
- Department of Neonatology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Charles D Kurth
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arjunan Ganesh
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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14
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Zhang Y, Jiang S, Liao F, Huang Z, Yang X, Zou Y, He X, Guo Q, Huang C. A transcriptomic analysis of neuropathic pain in the anterior cingulate cortex after nerve injury. Bioengineered 2022; 13:2058-2075. [PMID: 35030976 PMCID: PMC8973654 DOI: 10.1080/21655979.2021.2021710] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The anterior cingulate cortex (ACC) is a core brain region processing pain emotion. In this study, we performed RNA sequencing analysis to reveal transcriptomic profiles of the ACC in a rat chronic constriction injury (CCI) model. A total of 1628 differentially expressed genes (DEGs) were identified by comparing sham-operated rats with rats of 12 hours, 1, 3, 7, and 14 days after surgery, respectively. Although these inflammatory-related DEGs were generally increased after CCI, different kinetics of time-series expression were observed with the development of neuropathic pain affection. Specifically, the expression of Ccl5, Cxcl9 and Cxcl13 continued to increase following CCI. The expression of Ccl2, Ccl3, Ccl4, Ccl6, and Ccl7 were initially upregulated after CCI and subsequently decreased after 12 hours. Similarly, the expression of Rac2, Cd68, Icam-1, Ptprc, Itgb2, and Fcgr2b increased after 12 hours but reduced after 1 day. However, the expression of the above genes increased again 7 days after CCI, when the neuropathic pain affection had developed. Furthermore, gene ontology analysis, Kyoto Encyclopedia of Genes and Genomes pathway enrichment and interaction network analyses further showed a high connectivity degree among these chemokine targeting genes. Similar expressional changes in these genes were found in the rat spinal dorsal horn responsible for nociception processing. Taken together, our results indicated chemokines and their targeting genes in the ACC may be differentially involved in the initiation and maintenance of neuropathic pain affection. These genes may be a target for not only the nociception but also the pain affection following nerve injury.
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Affiliation(s)
- Yu Zhang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Shiwei Jiang
- Medical College of Xiangya, Central South University, Changsha, China
| | - Fei Liao
- Department of Anesthesiology, People's Hospital of Yuxi City, Yuxi, China
| | - Zhifeng Huang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Xin Yang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Zou
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Xin He
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Qulian Guo
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Changsheng Huang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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15
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Bukkieva T, Pospelova M, Efimtsev A, Fionik O, Alekseeva T, Samochernych K, Gorbunova E, Krasnikova V, Makhanova A, Levchuk A, Trufanov G, Combs S, Shevtsov M. Functional Network Connectivity Reveals the Brain Functional Alterations in Breast Cancer Survivors. J Clin Med 2022; 11:617. [PMID: 35160070 PMCID: PMC8837129 DOI: 10.3390/jcm11030617] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
Different neurological and psychiatric disorders such as vertebrobasilar insufficiency, chronic pain syndrome, anxiety, and depression are observed in more than 90% of patients after treatment for breast cancer and may cause alterations in the functional connectivity of the default mode network. The purpose of the present study is to assess changes in the functional connectivity of the default mode network in patients after breast cancer treatment using resting state functional magnetic resonance imaging (rs-fMRI). Rs-fMRI was performed using a 3.0T MR-scanner on patients (N = 46, women) with neurological disorders (chronic pain, dizziness, headaches, and/or tinnitus) in the late postoperative period (>12 months) after Patey radical mastectomy for breast cancer. According to the intergroup statistical analysis, there were differences in the functional connectivity of the default mode network in all 46 patients after breast cancer treatment compared to the control group (p < 0.01). The use of rs-fMRI in in breast cancer survivors allowed us to identify changes in the functional connectivity in the brain caused by neurological disorders, which correlated with a decreased quality of life in these patients. The results indicate the necessity to improve treatment and rehabilitation methods in this group of patients.
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Affiliation(s)
- Tatyana Bukkieva
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Maria Pospelova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Aleksandr Efimtsev
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Olga Fionik
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Tatyana Alekseeva
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Konstantin Samochernych
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Elena Gorbunova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Varvara Krasnikova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Albina Makhanova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Anatoliy Levchuk
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Gennadiy Trufanov
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Stephanie Combs
- Department of Radiation Oncology, Technishe Universität München (TUM), Klinikum rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany;
| | - Maxim Shevtsov
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
- Department of Radiation Oncology, Technishe Universität München (TUM), Klinikum rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany;
- Laboratory of Biomedical Nanotechnologies, Institute of Cytology of the Russian Academy of Sciences (RAS), Tikhoretsky Ave. 4, 194064 Saint Petersburg, Russia
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16
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Damascelli M, Woodward TS, Sanford N, Zahid HB, Lim R, Scott A, Kramer JK. Multiple Functional Brain Networks Related to Pain Perception Revealed by fMRI. Neuroinformatics 2022; 20:155-172. [PMID: 34101115 PMCID: PMC9537130 DOI: 10.1007/s12021-021-09527-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 01/07/2023]
Abstract
The rise of functional magnetic resonance imaging (fMRI) has led to a deeper understanding of cortical processing of pain. Central to these advances has been the identification and analysis of "functional networks", often derived from groups of pre-selected pain regions. In this study our main objective was to identify functional brain networks related to pain perception by examining whole-brain activation, avoiding the need for a priori selection of regions. We applied a data-driven technique-Constrained Principal Component Analysis for fMRI (fMRI-CPCA)-that identifies networks without assuming their anatomical or temporal properties. Open-source fMRI data collected during a thermal pain task (33 healthy participants) were subjected to fMRI-CPCA for network extraction, and networks were associated with pain perception by modelling subjective pain ratings as a function of network activation intensities. Three functional networks emerged: a sensorimotor response network, a salience-mediated attention network, and the default-mode network. Together, these networks constituted a brain state that explained variability in pain perception, both within and between individuals, demonstrating the potential of data-driven, whole-brain functional network techniques for the analysis of pain imaging data.
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Affiliation(s)
- Matteo Damascelli
- grid.17091.3e0000 0001 2288 9830Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC V6T 1Z4 Canada ,BC Mental Health & Addictions Research Institute, BC Children’s Hospital Research Institute, 938 West 28th Ave, Vancouver, BC V5Z 4H4 Canada ,grid.443934.d0000 0004 6336 7598ICORD, Blusson Spinal Cord Centre, 818 West 10th Ave, Vancouver, BC V5Z 1M9 Canada
| | - Todd S. Woodward
- BC Mental Health & Addictions Research Institute, BC Children’s Hospital Research Institute, 938 West 28th Ave, Vancouver, BC V5Z 4H4 Canada ,grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1 Canada
| | - Nicole Sanford
- BC Mental Health & Addictions Research Institute, BC Children’s Hospital Research Institute, 938 West 28th Ave, Vancouver, BC V5Z 4H4 Canada ,grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1 Canada
| | - Hafsa B. Zahid
- BC Mental Health & Addictions Research Institute, BC Children’s Hospital Research Institute, 938 West 28th Ave, Vancouver, BC V5Z 4H4 Canada ,grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1 Canada
| | - Ryan Lim
- BC Mental Health & Addictions Research Institute, BC Children’s Hospital Research Institute, 938 West 28th Ave, Vancouver, BC V5Z 4H4 Canada
| | - Alexander Scott
- grid.17091.3e0000 0001 2288 9830Department of Physical Therapy, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada ,grid.17091.3e0000 0001 2288 9830Centre for Hip Health and Mobility, Robert H. N. Ho Research Centre, 2635 Laurel St, Vancouver, BC V5Z 1M9 Canada
| | - John K. Kramer
- grid.443934.d0000 0004 6336 7598ICORD, Blusson Spinal Cord Centre, 818 West 10th Ave, Vancouver, BC V5Z 1M9 Canada ,grid.17091.3e0000 0001 2288 9830School of Kinesiology, University of British Columbia, 6081 University Blvd, Vancouver, BC V6T 1Z1 Canada
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17
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Oughourlian TC, Wang C, Salamon N, Holly LT, Ellingson BM. Sex-Dependent Cortical Volume Changes in Patients with Degenerative Cervical Myelopathy. J Clin Med 2021; 10:jcm10173965. [PMID: 34501413 PMCID: PMC8432178 DOI: 10.3390/jcm10173965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is a progressive condition characterized by degeneration of osseocartilaginous structures within the cervical spine resulting in compression of the spinal cord and presentation of clinical symptoms. Compared to healthy controls (HCs), studies have shown DCM patients experience structural and functional reorganization in the brain; however, sex-dependent cortical differences in DCM patients remains largely unexplored. In the present study, we investigate the role of sex differences on the structure of the cerebral cortex in DCM and determine how structural differences may relate to clinical measures of neurological function. T1-weighted structural MRI scans were acquired in 85 symptomatic and asymptomatic patients with DCM and 90 age-matched HCs. Modified Japanese Orthopedic Association (mJOA) scores were obtained for patients. A general linear model was used to determine vertex-level significant differences in gray matter volume (GMV) between the following groups (1) male HCs and female HCs, (2) male patients and female patients, (3) male patients and male HCs, and (4) female patients and female HCs. Within patients, males exhibited larger GMV in motor, language, and vision related brain regions compared to female DCM patients. Males demonstrated a significant positive correlation between GMV and mJOA score, in which patients with worsening neurological symptoms exhibited decreasing GMV primarily across somatosensory and motor related cortical regions. Females exhibited a similar association, albeit across a broader range of cortical areas including those involved in pain processing. In sensorimotor regions, female patients consistently showed smaller GMV compared with male patients, independent of mJOA score. Results from the current study suggest strong sex-related differences in cortical volume in patients with DCM, which may reflect hormonal influence or differing compensation mechanisms.
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Affiliation(s)
- Talia C. Oughourlian
- UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA; (T.C.O.); (C.W.); (B.M.E.)
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA;
- Neuroscience Interdepartmental Graduate Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Chencai Wang
- UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA; (T.C.O.); (C.W.); (B.M.E.)
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Langston T. Holly
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Correspondence: ; Tel.: +1-(310)-319-3475
| | - Benjamin M. Ellingson
- UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA; (T.C.O.); (C.W.); (B.M.E.)
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA;
- Neuroscience Interdepartmental Graduate Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
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Huo BB, Zheng MX, Hua XY, Shen J, Wu JJ, Xu JG. Metabolic Brain Network Analysis With 18F-FDG PET in a Rat Model of Neuropathic Pain. Front Neurol 2021; 12:566119. [PMID: 34276529 PMCID: PMC8284720 DOI: 10.3389/fneur.2021.566119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Neuropathic pain has been found to be related to profound reorganization in the function and structure of the brain. We previously demonstrated changes in local brain activity and functional/metabolic connectivity among selected brain regions by using neuroimaging methods. The present study further investigated large-scale metabolic brain network changes in 32 Sprague–Dawley rats with right brachial plexus avulsion injury (BPAI). Graph theory was applied in the analysis of 2-deoxy-2-[18F] fluoro-D-glucose (18F-FDG) PET images. Inter-subject metabolic networks were constructed by calculating correlation coefficients. Global and nodal network properties were calculated and comparisons between pre- and post-BPAI (7 days) status were conducted. The global network properties (including global efficiency, local efficiency and small-world index) and nodal betweenness centrality did not significantly change for all selected sparsity thresholds following BPAI (p > 0.05). As for nodal network properties, both nodal degree and nodal efficiency measures significantly increased in the left caudate putamen, left medial prefrontal cortex, and right caudate putamen (p < 0.001). The right entorhinal cortex showed a different nodal degree (p < 0.05) but not nodal efficiency. These four regions were selected for seed-based metabolic connectivity analysis. Strengthened connectivity was found among these seeds and distributed brain regions including sensorimotor area, cognitive area, and limbic system, etc. (p < 0.05). Our results indicated that the brain had the resilience to compensate for BPAI-induced neuropathic pain. However, the importance of bilateral caudate putamen, left medial prefrontal cortex, and right entorhinal cortex in the network was strengthened, as well as most of their connections with distributed brain regions.
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Affiliation(s)
- Bei-Bei Huo
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mou-Xiong Zheng
- Department of Traumatology and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Shen
- Department of Orthopedics, Guanghua Hospital of Integrative Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Jia Wu
- Department of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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19
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Ma L, Li J, Zhou J, Zhang D, Xiao Z, Yu T, Li Y, Cao S. Intravenous lidocaine alleviates postherpetic neuralgia in rats via regulation of neuroinflammation of microglia and astrocytes. iScience 2021; 24:102108. [PMID: 33604528 PMCID: PMC7876569 DOI: 10.1016/j.isci.2021.102108] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/30/2020] [Accepted: 01/21/2021] [Indexed: 12/28/2022] Open
Abstract
This study aimed to explore the effects and possible mechanisms of intravenous lidocaine in postherpetic neuralgia (PHN) rats. Mechanical withdrawal thresholds and thermal withdrawal latencies were measured. Open field test, elevated plus maze test, and tail suspension test were used to assess anxiety- and depressive-like behaviors. Microglia and astrocytes in spinal dorsal horn (SDH), prefrontal cortex (PFC), anterior cingulate cortex (ACC), and hippocampus were analyzed. The expression of TNF-α, IL-1β, and IL-4 in SDH and serum were evaluated. Intravenous lidocaine alleviated mechanical allodynia and thermal hypoalgesia, downregulated the expression of TNF-α and IL-1β, and inhibited the activation of microglia and astrocytes in SDH. In addition, it reduced the activation of astrocyte but not microglia in PFC, ACC, and hippocampus. Intravenous lidocaine may relieve PHN by inhibiting the activation of microglia and astrocyte in SDH or by reducing the neuroinflammation and astrocyte activation in PFC, ACC, and hippocampus. Intravenous lidocaine alleviates PHN in rats Intravenous lidocaine inhibits microglia and astrocyte activation Intravenous lidocaine cannot relieve anxiety and depression in PHN rats
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Affiliation(s)
- Lulin Ma
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Juan Li
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Junli Zhou
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Dexin Zhang
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhi Xiao
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China
| | - Tian Yu
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China
| | - Ying Li
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Song Cao
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China
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20
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Advances in imaging technologies for the assessment of peripheral neuropathies in rheumatoid arthritis. Rheumatol Int 2021; 41:519-528. [PMID: 33427917 DOI: 10.1007/s00296-020-04780-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/26/2020] [Indexed: 12/22/2022]
Abstract
Peripheral neuropathy in patients with rheumatoid arthritis is associated with a maladaptive autoimmune response that may cause chronic pain and disability. Nerve conduction studies are the routine method performed when rheumatologists presume its presence. However, this approach is invasive, may not reveal subtle malfunctions in the early stages of the disease, and does not expose abnormalities in structures surrounding the nerves and muscles, limiting the possibility of a timely diagnosis. This work aims to present a narrative review of new technologies for the clinical assessment of peripheral neuropathy in Rheumatoid Arthritis. Through a bibliographic search carried out in five repositories, from 1990 to 2020, we identified three technologies that could detect peripheral nerve lesions and perform quantitative evaluations: (1) magnetic resonance neurography, (2) functional magnetic resonance imaging, and (3) high-resolution ultrasonography of peripheral nerves. We found these tools can overcome the main constraints imposed by the previous electrophysiologic methods, enabling early diagnosis.
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21
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Changes in Functional Connectivity of Specific Cerebral Regions in Patients with Toothache: A Resting-State Functional Magnetic Resonance Imaging Study. DISEASE MARKERS 2020; 2020:6683161. [PMID: 33456630 PMCID: PMC7785343 DOI: 10.1155/2020/6683161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/31/2022]
Abstract
Objective In order to further study the changes of cerebral functional connectivity in patients with toothache (TA), this study used the resting-state functional magnetic resonance imaging (rs-fMRI) technique and degree centrality (DC) analysis method. Methods Eighteen TA patients (8 males, 10 females) and 18 healthy individuals of similar age, sex, and educational levels were recruited as healthy controls (HCs) to take part in the study, and all underwent rs-fMRI examination. And DC technology was used to compare the state of their cerebral spontaneous functional activity. In order to compare the average DC values of the TA group and HC group, we used independent two-sample t-test and receiver operating characteristic (ROC) curve to compare the difference of DC values between the two groups, so as to distinguish the accuracy of TA diagnosis. Finally, we also carry out Pearson's linear regression analysis. Results The TA group showed higher DC values in the right lingual gyrus (RLG), right precentral gyrus, and left middle temporal gyrus (LMTG) than HCs. Moreover, ROC curve analysis indicated that the area under the curve (AUC) of each cerebral region studied had high accuracy. In addition, linear analysis indicated that the DC values of the RLG were positively correlated with the Hospital Anxiety and Depression Scale (HADS) (r = 0.844, p < 0.001), and the DC values of the LMTG were positively correlated with the visual analogue scale (VAS) (r = 0.723, p < 0.001). Conclusion TA generates abnormal changes in the intrinsic activity patterns of pain-related and vision-related areas of the cerebral cortex, which will be beneficial to reveal the underlying neuropathic mechanisms.
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22
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Neuropathic pain in individuals with sickle cell disease. Neurosci Lett 2020; 714:134445. [DOI: 10.1016/j.neulet.2019.134445] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/06/2019] [Accepted: 08/20/2019] [Indexed: 12/18/2022]
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Lee YC, Fine A, Protsenko E, Massarotti E, Edwards RR, Mawla I, Napadow V, Loggia ML. Brain Correlates of Continuous Pain in Rheumatoid Arthritis as Measured by Pulsed Arterial Spin Labeling. Arthritis Care Res (Hoboken) 2019; 71:308-318. [PMID: 29781581 DOI: 10.1002/acr.23601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 05/15/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Central nervous system pathways involving pain modulation shape the pain experience in patients with chronic pain. The aims of this study were to understand the mechanisms underlying pain in patients with rheumatoid arthritis (RA) and to identify brain signals that may serve as imaging markers for developing targeted treatments for RA-related pain. METHODS Patients with RA and matched control subjects underwent functional magnetic resonance imaging, using pulsed arterial spin labeling. The imaging conditions included 1) resting state, 2) low-intensity stimulus, and 3) high-intensity stimulus. Stimuli consisted of mechanical pressure applied to metacarpophalangeal (MCP) joints with an automated cuff inflator. The low-intensity stimulus was inflation to 30 mm Hg. The high-intensity stimulus was the amount of pressure required to achieve a pain intensity rating of 40 on a 100-point scale for each RA patient, with the same amount of pressure used in the matched control. RESULTS Among RA patients, regional cerebral blood flow (rCBF) in the medial frontal cortex and dorsolateral prefrontal cortex increased during both low-pressure and high-pressure stimulation. No rCBF changes were observed in pain-free controls. Region-of-interest analyses in RA patients showed that baseline rCBF in the medial frontal cortex was negatively correlated with the pressure required for the high-intensity stimulus and positively correlated with pain induced by the low-intensity stimulus. Baseline rCBF was also marginally correlated with disease activity). Regional CBF during high pain was positively correlated with pain severity and pain interference. CONCLUSION In response to clinically relevant joint pain evoked by pressure applied to the MCP joint, neural processing in the medial frontal cortex increases and is directly associated with clinical pain in patients with RA.
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Affiliation(s)
- Yvonne C Lee
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alexander Fine
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ekaterina Protsenko
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elena Massarotti
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert R Edwards
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ishtiaq Mawla
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vitaly Napadow
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marco L Loggia
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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24
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The "virtual lesion" approach to transcranial magnetic stimulation: studying the brain-behavioral relationships in experimental pain. Pain Rep 2019; 4:e760. [PMID: 31579852 PMCID: PMC6728008 DOI: 10.1097/pr9.0000000000000760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 12/11/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) can be used to create a temporary “virtual lesion” (VL) of a target cortical area, disrupting its function and associated behavior. Transcranial magnetic stimulation can therefore test the functional role of specific brain areas. This scoping review aims at investigating the current literature of the “online” TMS-evoked VL approach to studying brain–behavioral relationships during experimental pain in healthy subjects. Ovid-Medline, Embase, and Web of Science electronic databases were searched. Included studies tested different TMS-based VLs of various pain brain areas during continuous experimental pain or when time-locked to a noxious stimulus. Outcome measures assessed different pain measurements. Initial screening resulted in a total of 403 studies, of which 17 studies were included in the review. The VLs were directed to the prefrontal, primary and secondary somatosensory, primary motor, and parietal cortices through single/double/triple/sequence of five-TMS pulses or through repeated TMS during mechanical, electrical contact, radiant heat, or capsaicin-evoked noxious stimulation. Despite a wide variability among the VL protocols, outcome measures, and study designs, a behavioral VL effect (decrease or increase in pain responses) was achieved in the majority of the studies. However, such findings on the relationships between the modified brain activity and the manifested pain characteristics were often mixed. To conclude, TMS–elicited VLs during experimental pain empower our understanding of brain–behavior relationships at specific time points during pain processing. The mixed findings of these relationships call for an obligatory standard of all pain-related TMS protocols for clearly determining the magnitude and direction of TMS-induced behavioral effects.
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Shillo P, Sloan G, Greig M, Hunt L, Selvarajah D, Elliott J, Gandhi R, Wilkinson ID, Tesfaye S. Painful and Painless Diabetic Neuropathies: What Is the Difference? Curr Diab Rep 2019; 19:32. [PMID: 31065863 PMCID: PMC6505492 DOI: 10.1007/s11892-019-1150-5] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The prevalence of diabetes mellitus and its chronic complications are increasing to epidemic proportions. This will unfortunately result in massive increases in diabetic distal symmetrical polyneuropathy (DPN) and its troublesome sequelae, including disabling neuropathic pain (painful-DPN), which affects around 25% of patients with diabetes. Why these patients develop neuropathic pain, while others with a similar degree of neuropathy do not, is not clearly understood. This review will look at recent advances that may shed some light on the differences between painful and painless-DPN. RECENT FINDINGS Gender, clinical pain phenotyping, serum biomarkers, brain imaging, genetics, and skin biopsy findings have been reported to differentiate painful- from painless-DPN. Painful-DPN seems to be associated with female gender and small fiber dysfunction. Moreover, recent brain imaging studies have found neuropathic pain signatures within the central nervous system; however, whether this is the cause or effect of the pain is yet to be determined. Further research is urgently required to develop our understanding of the pathogenesis of pain in DPN in order to develop new and effective mechanistic treatments for painful-DPN.
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Affiliation(s)
- Pallai Shillo
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF UK
| | - Gordon Sloan
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF UK
| | - Marni Greig
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF UK
| | - Leanne Hunt
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF UK
| | - Dinesh Selvarajah
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK
| | - Jackie Elliott
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK
| | - Rajiv Gandhi
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF UK
| | | | - Solomon Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF UK
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK
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26
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Yang J, Li B, Yu QY, Ye L, Zhu PW, Shi WQ, Yuan Q, Min YL, He YL, Shao Y. Altered intrinsic brain activity in patients with toothaches using the amplitude of low-frequency fluctuations: a resting-state fMRI study. Neuropsychiatr Dis Treat 2019; 15:283-291. [PMID: 30697053 PMCID: PMC6342150 DOI: 10.2147/ndt.s189962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The results of previous studies have indicated that pain-associated diseases can result in marked functional and anatomical alterations in the brain. However, differences in spontaneous brain activity occurring in toothache (TA) patients remain unclear. OBJECTIVE This study investigated intrinsic brain activity changes in TA subjects using the amplitude of low-frequency fluctuation (ALFF) technique. METHODS A total of 18 patients with TA (eight males, and 10 females) and 18 healthy controls (HCs) who were matched for gender, age, and educational status were enrolled. Resting-state functional MRI was used to examine the participants. Spontaneous cerebral activity variations were investigated using the ALFF technique. The mean ALFF values of the TA patients and the HCs were classified using receiver operating characteristic (ROC) curves. The correlations between ALFF signals of distinct regions of the cerebrum and the clinical manifestations of the TA patients were evaluated using Pearson's correlation analysis. RESULTS Compared with HCs, TA patients showed notably higher ALFF in the left postcentral gyrus, right paracentral lobule, right lingual gyrus, right inferior occipital gyrus, left fusiform gyrus, and right superior occipital gyrus. ROC curve analysis of each brain region showed that the accuracy area under the curve was excellent. In the TA group, the visual analog scale of the left side was positively correlated with the ALFF signal values of the right paracentral lobule (r=0.639, P=0.025). CONCLUSION Multiple brain regions, including pain- and vision-related areas, exhibited aberrant intrinsic brain activity patterns, which may help to explain the underlying neural mechanisms in TA.
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Affiliation(s)
- Jun Yang
- Department of Prosthodontics, The Affiliated Stomatological Hospital of Nanchang University, Nanchang, China
| | - Bin Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China,
| | - Qiu-Yue Yu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China,
| | - Lei Ye
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China,
| | - Pei-Wen Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China,
| | - Wen-Qing Shi
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China,
| | - Qing Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China,
| | - You-Lan Min
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China,
| | - Yu-Lin He
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China,
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China,
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Liu LY, Zhang RL, Chen L, Zhao HY, Cai J, Wang JK, Guo DQ, Cui YJ, Xing GG. Chronic stress increases pain sensitivity via activation of the rACC-BLA pathway in rats. Exp Neurol 2018; 313:109-123. [PMID: 30586593 DOI: 10.1016/j.expneurol.2018.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/21/2018] [Indexed: 01/05/2023]
Abstract
Exposure to chronic stress can produce maladaptive neurobiological changes in pathways associated with pain processing, which may cause stress-induced hyperalgesia (SIH). However, the underlying mechanisms still remain largely unknown. In previous studies, we have reported that the amygdala is involved in chronic forced swim (FS) stress-induced depressive-like behaviors and the exacerbation of neuropathic pain in rats, of which, the basolateral amygdala (BLA) and the central nucleus of the amygdala (CeA) are shown to play important roles in the integration of affective and sensory information including nociception. Here, using in vivo multichannel recording from rostal anterior cingulate cortex (rACC) and BLA, we found that chronic FS stress (CFSS) could increase the pain sensitivity of rats in response to low intensity innoxious stimuli (LIS) and high intensity noxious stimuli (HNS) imposed upon the hindpaw, validating the occurrence of SIH in stressed rats. Moreover, we discovered that CFSS not only induced an increased activity of rACC neuronal population but also produced an augmented field potential power (FPP) of rACC local field potential (LFP), especially in low frequency theta band as well as in high frequency low gamma band ranges, both at the baseline state and under LIS and HNS conditions. In addition, by using a cross-correlation method and a partial directed coherence (PDC) algorithm to analyze the LFP oscillating activity in rACC and BLA, we demonstrated that CFSS could substantially promote the synchronization between rACC and BLA regions, and also enhanced the neural information flow from rACC to BLA. We conclude that exposure of chronic FS stress to rats could result in an increased activity of rACC neuronal population and promote the functional connectivity and the synchronization between rACC and BLA regions, and also enhance the pain-related neural information flow from rACC to BLA, which likely underlie the pathogenesis of SIH.
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Affiliation(s)
- Ling-Yu Liu
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Peking University, Beijing 100083, China
| | - Rui-Ling Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Henan, Xinxiang 453002, China
| | - Lin Chen
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Peking University, Beijing 100083, China
| | - Hong-Yan Zhao
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Peking University, Beijing 100083, China
| | - Jie Cai
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Peking University, Beijing 100083, China; Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Beijing 100083, China
| | - Jia-Kang Wang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Da-Qing Guo
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Yan-Jun Cui
- Department of Internal Medicine, Peking University Hospital, Beijing 100871, China.
| | - Guo-Gang Xing
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Peking University, Beijing 100083, China; The Second Affiliated Hospital of Xinxiang Medical University, Henan, Xinxiang 453002, China; Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Beijing 100083, China.
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28
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Straube A, Ruscheweyh R. [Pain - The most interesting new findings in the last ten years]. MMW Fortschr Med 2018; 160:111-115. [PMID: 30421182 DOI: 10.1007/s15006-018-1137-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Andreas Straube
- Neurologie, Klinikum Großhadern, Ludwig-Maximilians Universität, Marchioninistraße 15, D-81377, München, Deutschland.
| | - Ruth Ruscheweyh
- Neurologie, Klinikum Großhadern, Ludwig-Maximilians Universität, Marchioninistraße 15, D-81377, München, Deutschland
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Xiang Y, Wang Y, Gao S, Zhang X, Cui R. Neural Mechanisms With Respect to Different Paradigms and Relevant Regulatory Factors in Empathy for Pain. Front Neurosci 2018; 12:507. [PMID: 30087592 PMCID: PMC6066512 DOI: 10.3389/fnins.2018.00507] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 07/04/2018] [Indexed: 12/16/2022] Open
Abstract
Empathy for pain is thought to activate the affective-motivational components of the pain matrix, which includes the anterior insula and middle and anterior cingulate cortices, as indicated by functional magnetic resonance imaging and other methodologies. Activity in this core neural network reflects the affective experience that activates our responses to pain and lays the neural foundation for our understanding of our own emotions and those of others. Furthermore, although picture-based paradigms can activate somatosensory components of directly experienced pain, cue-based paradigms cannot. In addition to this difference, the two paradigms evoke other distinct neuronal responses. Although the automatic “perception-action” model has long been the dominant theory for pain empathy, a “bottom-up, top-down” mechanism seems to be more comprehensive and persuasive. Indeed, a variety of factors can regulate the intensity of empathy for pain through “top-down” processes. In this paper, we integrate and generalize knowledge regarding pain empathy and introduce the findings from recent studies. We also present ideas for future research into the neural mechanisms underlying pain empathy.
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Affiliation(s)
- Yien Xiang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital Jilin University, Changchun, China
| | - Yicun Wang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital Jilin University, Changchun, China
| | - Shuohui Gao
- Department of Gastrointestinal Colorectal Surgery, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Xuewen Zhang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital Jilin University, Changchun, China
| | - Ranji Cui
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital Jilin University, Changchun, China
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30
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Hori S, Oda S, Suehiro Y, Iino Y, Mitani S. OFF-responses of interneurons optimize avoidance behaviors depending on stimulus strength via electrical synapses. PLoS Genet 2018; 14:e1007477. [PMID: 29939997 PMCID: PMC6034901 DOI: 10.1371/journal.pgen.1007477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 07/06/2018] [Accepted: 06/07/2018] [Indexed: 12/21/2022] Open
Abstract
Optimization of the types and timing of avoidance behaviors depending on the intensity of a noxious stimulus is essential for survival; however, processing in the central nervous system and its developmental basis are largely unknown. Here, we report that Caenorhabditis elegans preferentially selects one of three different types of avoidance behaviors depending on the strength of the noxious stimulus. We screened 210 neuronal transcription factors using a combination of optogenetics and RNA interference methods and identified 19 candidates required for avoidance behaviors. One candidate, gene lin-32 (abnormal cellLINeage32), which encodes an atonal homolog, is required for the neural fate determination of AIB interneurons and functions by regulating the expression of electrical and chemical synapse genes, namely, inx-1 (innexin 1) and AMPA-type ionotropic glutamate receptor glr-1. When examined by Ca imaging, AIB showed an OFF calcium increase to the noxious stimulus. The OFF calcium increase was provoked only by strong stimulation, suggesting a role for optimization of the avoidance behavior. However, lin-32 mutants showed an impaired AIB OFF calcium increase, concomitant with a reduced occurrence of the dynamic avoidance behavior called the "omega turn". The AIB neural responses may be transferred to downstream inter/motor neurons projecting to the neck muscles via electrical synapses comprising inx-1. Finally, we found a correlation between powerful contractions of the neck muscles and omega turns. Thus, the central regulation of the magnitude and timing of activation of the AIB interneurons optimizes the probability of omega turn depending on the stimulus context. For survival, animals exhibit appropriate behaviors depending on the type and strength of a stimulus; however, processing in the central nervous system and its developmental basis are largely unknown. Here, we performed RNA interference screening of 210 transcription factors by observing the avoidance behaviors evoked by a harmful stimulus and identified 19 candidates with behavioral defects. One candidate gene, lin-32, which encodes a homologue of a well-conserved transcription factor, atonal, that plays a key role in cell type specification, is required for the optimization of avoidance behaviors. lin-32 regulates the expression of various synaptic genes in the key neurons required for the optimization of avoidance behaviors. The key neurons respond at the time of the removal of the strong stimulation, and an appropriate magnitude and timing of the calcium increase are required to determine the type and timing of dynamic avoidance behaviors. However, the key neuronal response does not occur in the lin-32 mutants. Activation of the key neurons may be transferred to the downstream neurons projecting to the neck muscles via electrical synapses. Finally, we show a correlation between powerful neck muscle contractions and dynamic avoidance behaviors.
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Affiliation(s)
- Sayaka Hori
- Department of Physiology, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
| | - Shigekazu Oda
- Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo, Japan
| | - Yuji Suehiro
- Department of Physiology, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
| | - Yuichi Iino
- Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo, Japan
| | - Shohei Mitani
- Department of Physiology, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
- * E-mail:
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Luz-Santos C, Ribeiro Camatti J, Barbosa Paixão A, Nunes Sá K, Montoya P, Lee M, Fontes Baptista A. Additive effect of tDCS combined with Peripheral Electrical Stimulation to an exercise program in pain control in knee osteoarthritis: study protocol for a randomized controlled trial. Trials 2017; 18:609. [PMID: 29268764 PMCID: PMC5740917 DOI: 10.1186/s13063-017-2332-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/08/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) has been linked to maladaptive plasticity in the brain, which may contribute to chronic pain. Neuromodulatory approaches, such as Transcranial Direct Current Stimulation (tDCS) and Peripheral Electrical Stimulation (PES), have been used therapeutically to counteract brain maladaptive plasticity. However, it is currently unclear whether these neuromodulatory techniques enhance the benefits of exercise when administered together. Therefore, this protocol aims to investigate whether the addition of tDCS combined or not with PES enhances the effects of a land-based strengthening exercise program in patients with knee OA. METHODS Patients with knee OA (n = 80) will undertake a structured exercise program for five consecutive days. In addition, they will be randomized into four subgroups receiving either active anodal tDCS and sham PES (group 1; n = 20), sham tDCS and active PES (group 2, n = 20), sham tDCS and PES (group 3, n = 20), or active tDCS and PES (group 4, n = 20) for 20 min/day for five consecutive days just prior to commencement of the exercise program. The primary outcomes will be subjective pain intensity (VAS) and related function (WOMAC). Secondary outcomes will include quality of life (SF-36), anxiety and depression symptoms (HAD), self-perception of improvement, pressure pain thresholds over the knee, quadriceps strength, and quadriceps electromyographic activity during maximum knee extension voluntary contraction. We will also investigate cortical excitability using transcranial magnetic stimulation. Outcome measures will be assessed at baseline, 1 month after, before any intervention, after 5 days of intervention, and at 1 month post exercise intervention. DISCUSSION The motor cortex becomes less responsive in knee OA because of poorly adapted plastic changes, which can impede exercise therapy benefits. Adding tDCS and/or PES may help to counteract those maladaptive plastic changes and improve the benefits of exercises, and the combination of both neuromodulatory techniques must have a higher magnitude of effect. TRIAL REGISTRATION Brazilian Registry on Clinical Trials (ReBEC) - Effects of electrical stimulation over the skull and tight together with exercises for knee OA; protocol number RBR-9D7C7B. TRIAL REGISTRATION ID: RBR-9D7C7B . Registered on 29 February 2016.
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Affiliation(s)
- Cleber Luz-Santos
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Graduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Janine Ribeiro Camatti
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, São Paulo 09.080-045 Brazil
- Graduate Program in Neuroscience and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Alaí Barbosa Paixão
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Graduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Katia Nunes Sá
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Bahian School of Medicine and Public Health, Salvador, Brazil
| | - Pedro Montoya
- Research Institute on Health Sciences, University of Balearic Islands, Palma de Majorca, Spain
| | - Michael Lee
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, NSW Australia
| | - Abrahão Fontes Baptista
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Graduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, São Paulo 09.080-045 Brazil
- Graduate Program in Neuroscience and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
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Sancassiani F, Machado S, Ruggiero V, Cacace E, Carmassi C, Gesi C, Dell'Osso L, Carta MG. The management of fibromyalgia from a psychosomatic perspective: an overview. Int Rev Psychiatry 2017; 29:473-488. [PMID: 28681628 DOI: 10.1080/09540261.2017.1320982] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fibromyalgia (FM) is a central sensitization syndrome characterized by chronic widespread pain. FM is often comorbid with psychiatric disorders, as well as psychological distress that worsens the quality-of-life of people affected. The aim was to collect current evidence about the management of FM from a psychosomatic perspective. The literature was synthesized and summarized in a narrative format. The literature search was carried out in PubMed; review articles, meta-analysis, overview, and guidelines published in the last 10 years written in English were included. Five main topics (Diagnostic criteria of FM; Pathogenesis of chronic widespread pain in FM; Early stress and trauma as predisposing factors for central sensitization; FM and Psychiatric comorbidity; Implications for treatment) were pointed out and discussed. Much evidence underlies the importance of considering and treating the comorbidity of FM with psychiatric disorders and psychological factors that affect pain management. Validation of FM as a central sensitization syndrome by a clinician facilitates therapeutic strategies that involve patients as active participants in the pain management process, likely leading to improved outcomes.
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Affiliation(s)
- Federica Sancassiani
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Sergio Machado
- b Laboratory of Panic and Respiration , Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB/UFRJ) , Rio de Janeiro , RJ , Brazil.,c Physical Activity Neuroscience , Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University , Niterói , Brazil
| | - Valeria Ruggiero
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Enrico Cacace
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Claudia Carmassi
- d Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Camilla Gesi
- d Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Liliana Dell'Osso
- d Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Mauro Giovanni Carta
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
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Niérat MC, Laviolette L, Hudson A, Similowski T, Sévoz-Couche C. Experimental dyspnea as a stressor: differential cardiovegetative responses to inspiratory threshold loading in healthy men and women. J Appl Physiol (1985) 2017; 123:205-212. [DOI: 10.1152/japplphysiol.00078.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/18/2017] [Accepted: 04/27/2017] [Indexed: 01/21/2023] Open
Abstract
Dyspnea is associated with an emotional reaction that involves limbic activation. The inspiratory threshold load (ITL) is known to elicit a dyspneic response in healthy subjects. Laboratory-induced stress conditions have been shown to elicit sex-related differences in cardiovascular responses. The aim of this study was to evaluate how healthy men ( n = 8) and women ( n = 9) react and adapt to 5-min periods of ITL at three levels (low, medium, and high) in terms of heart rate (HR), temporal (RMSSD) and spectral (LF, HF, LF/HF ratio) HRV indexes, and rating of breathing discomfort. HR increased with low, medium, and high ITL in men, whereas it increased only with high ITL in women. LF/HF ratio increased at low ITL in both men and women. Modifications appear to depend essentially on increased LF in men and on reduced HF in women. In addition, HRV modifications differ between men and women, following the order of presentation of ITLs. Our results show a continuous and sustained stress in men (increased HR, LF, and LF/HF ratio across ITL presentation) and a stress adaptation in women. Subjective responses of breathing discomfort were not correlated with sympatho-vagal balance modifications for a subgroup of subjects ( n = 10). Breathing against the ITL induced autonomic modifications that are different between men and women, i.e., driven by sympathetic mediated responses in men, whereas women showed a greater parasympathetic modulation of cardiovascular activity. These results highlight the role of the mechanical inspiratory load in the heart rate variability seen in chronic obstructive pulmonary disease. NEW & NOTEWORTHY Breathing against the ITL induced autonomic modifications driven by sympathetic mediated responses in men, whereas women showed a greater parasympathetic modulation of cardiovascular activity, even for low load. A stress circuit could be at the origin of autonomic modifications induced by ITL. Our results would underline the role of the mechanic inspiratory load in the abnormalities in heart rate variability seen in COPD patients.
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Affiliation(s)
- Marie-Cécile Niérat
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
| | - Louis Laviolette
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada; and
| | - Anna Hudson
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
- Neuroscience Research Australia and University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Similowski
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (“Département R3S”), Paris, France
| | - Caroline Sévoz-Couche
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
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Emmert K, Breimhorst M, Bauermann T, Birklein F, Rebhorn C, Van De Ville D, Haller S. Active pain coping is associated with the response in real-time fMRI neurofeedback during pain. Brain Imaging Behav 2017; 11:712-721. [PMID: 27071949 PMCID: PMC5486591 DOI: 10.1007/s11682-016-9547-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback is used as a tool to gain voluntary control of activity in various brain regions. Little emphasis has been put on the influence of cognitive and personality traits on neurofeedback efficacy and baseline activity. Here, we assessed the effect of individual pain coping on rt-fMRI neurofeedback during heat-induced pain. Twenty-eight healthy subjects completed the Coping Strategies Questionnaire (CSQ) prior to scanning. The first part of the fMRI experiment identified target regions using painful heat stimulation. Then, subjects were asked to down-regulate the pain target brain region during four neurofeedback runs with painful heat stimulation. Functional MRI analysis included correlation analysis between fMRI activation and pain ratings as well as CSQ ratings. At the behavioral level, the active pain coping (first principal component of CSQ) was correlated with pain ratings during neurofeedback. Concerning neuroimaging, pain sensitive regions were negatively correlated with pain coping. During neurofeedback, the pain coping was positively correlated with activation in the anterior cingulate cortex, prefrontal cortex, hippocampus and visual cortex. Thermode temperature was negatively correlated with anterior insula and dorsolateral prefrontal cortex activation. In conclusion, self-reported pain coping mechanisms and pain sensitivity are a source of variance during rt-fMRI neurofeedback possibly explaining variations in regulation success. In particular, active coping seems to be associated with successful pain regulation.
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Affiliation(s)
- Kirsten Emmert
- Department of Radiology and Medical Informatics, CIBM, University Hospital Geneva, Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
- Medical Image Processing Laboratory, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Markus Breimhorst
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Bauermann
- Institute of Neuroradiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Frank Birklein
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Cora Rebhorn
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Dimitri Van De Ville
- Department of Radiology and Medical Informatics, CIBM, University Hospital Geneva, Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Medical Image Processing Laboratory, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Sven Haller
- Affidea Centre de Diagnostic Radiologique de Carouge CDRC, Geneva, Switzerland
- Faculty of Medicine of the University of Geneva, Geneva, Switzerland
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Germany
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The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms. THE JOURNAL OF PAIN 2017; 18:359.e1-359.e38. [DOI: 10.1016/j.jpain.2016.11.004] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 10/15/2016] [Accepted: 11/16/2016] [Indexed: 01/01/2023]
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Jin L, Yang X, Liu P, Sun J, Chen F, Xu Z, Qin W, Tian J. Dynamic abnormalities of spontaneous brain activity in women with primary dysmenorrhea. J Pain Res 2017; 10:699-707. [PMID: 28392711 PMCID: PMC5373826 DOI: 10.2147/jpr.s121286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE This study aimed to investigate the regional spontaneous brain activity changes in primary dysmenorrhea (PD) patients in different phases of the menstrual cycle by regional homogeneity (ReHo) analysis. PATIENTS AND METHODS Thirty-three PD patients and 32 healthy controls (HCs) separately received resting-state functional magnetic resonance imaging during menstrual phase and follicular phase (non-menstrual phase). Cox retrospective symptom scale (RSS), Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were applied to assess related symptoms and emotions. RESULTS There was no significant difference between the two groups in demographic data. The PD patients obtained higher RSS score, SAS score and SDS score than HCs. Compared with HCs, the ReHo values of the PD patients were increased in left midbrain and hippocampus, right posterior cingulate cortex (PCC), insula and middle temporal cortex (MTC) and decreased in left dorsolateral prefrontal cortex and right medial prefrontal cortex (mPFC) in menstrual phase. In non-menstrual phase, enhanced ReHo values were found in bilateral S1 and precuneus, left S2 and MTC, and reduced ReHo values were observed in left mPFC and orbital frontal cortex. RSS score positively correlated with ReHo values of midbrain and negatively correlated with mPFC and PCC. CONCLUSION Our results suggested that PD is accompanied by dynamic regional spontaneous activity changes across the menstrual cycle, and the altered regions were involved in descending pain modulation, default mode network and sensory modulation. These abnormal activations might contribute to maintain the menstrual pain.
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Affiliation(s)
- Lingmin Jin
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Xuejuan Yang
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Peng Liu
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Jinbo Sun
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Fei Chen
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Ziliang Xu
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Wei Qin
- Sleep and Neuroimage Group, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi
| | - Jie Tian
- Institute of Automation, Chinese Academy of Sciences, Beijing, People's Republic of China
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Li Y, Wang Y, Xuan C, Li Y, Piao L, Li J, Zhao H. Role of the Lateral Habenula in Pain-Associated Depression. Front Behav Neurosci 2017; 11:31. [PMID: 28270756 PMCID: PMC5318408 DOI: 10.3389/fnbeh.2017.00031] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/09/2017] [Indexed: 11/13/2022] Open
Abstract
Patients with chronic pain have significantly higher incidences of depression and anxiety than the average person. However, the mechanism underlying this link has not been elucidated in terms of how chronic pain causes significant mood changes and further develops into severe anxiety or depression. The serotonergic system in the raphe nuclei is an important component in both pain processing and the pathogenesis of depression. Since the lateral habenular nucleus (LHb) controls the raphe nuclei, it may participate in the regulation of pain-associated depression. Thus, the aim of the current study was to investigate the role of the LHb in this pathophysiological process. We used chronic constriction injury (CCI) of the sciatic nerve in rats as a model for neuropathic pain and assessed the changes potentially related to the mood disorders. The forced swim test (FST) and sucrose preference test (SPT) were performed to determine the behavioral changes 28 days after pain surgery. Expression of β calmodulin-dependent protein kinase type II (βCaMKII) in the LHb, cytochrome-c oxidase (COX) activity in the LHb and dorsal raphe nucleus (DRN) and serotonin (5-HT) levels in the DRN were measured. We found an increasing in LHb activity and βCaMKII expression, and a decrease in neuronal activity in the DRN and 5-hydroxyindoleacetic acid (5-HIAA)/5-HT ratios in the CCI rats. These effects were accompanied by the depression-like behaviors. Lesions in the LHb improved the pain threshold and depression-like behavior in the rats. These results suggest that the LHb may play a role in pain-associated depression by affecting the activity of 5-HT neurons in the DRN. Furthermore, we showed that increases in the LHb-DRN pathway activity were a common neurobiological mechanisms for pain and depression, which may explain the coexistence of pain and depression.
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Affiliation(s)
- Yanhui Li
- Department of Physiology, College of Basic Medical Sciences, Jilin UniversityChangchun, China; Department of Anesthesia, Neuroscience Research Center, First Hospital of Jilin UniversityChangchun, China
| | - Yumeng Wang
- Department of Physiology, College of Basic Medical Sciences, Jilin University Changchun, China
| | - Chengluan Xuan
- Department of Anesthesia, Neuroscience Research Center, First Hospital of Jilin University Changchun, China
| | - Yang Li
- Department of Physiology, College of Basic Medical Sciences, Jilin University Changchun, China
| | - Lianhua Piao
- Department of Physiology, College of Basic Medical Sciences, Jilin University Changchun, China
| | - Jicheng Li
- Department of Physiology, College of Basic Medical Sciences, Jilin University Changchun, China
| | - Hua Zhao
- Department of Physiology, College of Basic Medical Sciences, Jilin UniversityChangchun, China; Department of Anesthesia, Neuroscience Research Center, First Hospital of Jilin UniversityChangchun, China
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Alomar S, Bakhaidar M. Neuroimaging of neuropathic pain: review of current status and future directions. Neurosurg Rev 2016; 41:771-777. [DOI: 10.1007/s10143-016-0807-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/24/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
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Fischer IW, Hansen TM, Lelic D, Brokjaer A, Frøkjær J, Christrup LL, Olesen AE. Objective methods for the assessment of the spinal and supraspinal effects of opioids. Scand J Pain 2016; 14:15-24. [PMID: 28850426 DOI: 10.1016/j.sjpain.2016.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Opioids are potent analgesics. Opioids exert effects after interaction with opioid receptors. Opioid receptors are present in the peripheral- and central nervous system (CNS), but the analgesic effects are primarily mediated via receptors in the CNS. Objective methods for assessment of opioid effects may increase knowledge on the CNS processes responsible for analgesia. The aim of this review was to provide an overview of the most common objective methods for assessment of the spinal and supraspinal effects of opioids and discuss their advantages and limitations. METHOD The literature search was conducted in Pub Med (http://www.ncbi.nlm.nih.gov/pubmed) from November 2014 to June 2016, using free-text terms: "opioid", "morphine" and "oxycodone" combined with the terms "pupillometry," "magnetic resonance spectroscopy," "fMRI," "BOLD," "PET," "pharmaco-EEG", "electroencephalogram", "EEG," "evoked potentials," and "nociceptive reflex". Only original articles published in English were included. RESULTS For assessment of opioid effects at the supraspinal level, the following methods are evaluated: pupillometry, proton magnetic resonance spectroscopy, functional resonance magnetic imaging (fMRI), positron emission tomography (PET), spontaneous electroencephalogram (EEG) and evoked potentials (EPs). Pupillometry is a non-invasive tool used in research as well as in the clinical setting. Proton magnetic resonance spectroscopy has been used for the last decades and it is a non-invasive technique for measurement of in vivo brain metabolite concentrations. fMRI has been a widely used non-invasive method to estimate brain activity, where typically from the blood oxygen level-dependent (BOLD) signal. PET is a nuclear imaging technique based on tracing radio labeled molecules injected into the blood, where receptor distribution, density and activity in the brain can be visualized. Spontaneous EEG is typically quantified in frequency bands, power spectrum and spectral edge frequency. EPs are brain responses (assessed by EEG) to a predefined number of short phasic stimuli. EPs are quantified by their peak latencies and amplitudes, power spectrum, scalp topographies and brain source localization. For assessment of opioid effects at the spinal level, the following methods are evaluated: the nociceptive withdrawal reflex (NWR) and spinal EPs. The nociceptive withdrawal reflex can be recorded from all limbs, but it is standard to record the electromyography signal at the biceps femoris muscle after stimulation of the ipsilateral sural nerve; EPs can be recorded from the spinal cord and are typically recorded after stimulation of the median nerve at the wrist. CONCLUSION AND IMPLICATIONS The presented methods can all be used as objective methods for assessing the centrally mediated effects of opioids. Advantages and limitations should be considered before implementation in drug development, future experimental studies as well as in clinical settings. In conclusion, pupillometry is a sensitive measurement of opioid receptor activation in the CNS and from a practical and economical perspective it may be used as a biomarker for opioid effects in the CNS. However, if more detailed information is needed on opioid effects at different levels of the CNS, then EEG, fMRI, PET and NWR have the potential to be used. Finally, it is conceivable that information from different methods should be considered together for complementary information.
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Affiliation(s)
- Iben W Fischer
- Mech-Sense, Department of Gastroenterology &Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.,Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tine M Hansen
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dina Lelic
- Mech-Sense, Department of Gastroenterology &Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
| | - Anne Brokjaer
- Mech-Sense, Department of Gastroenterology &Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
| | - Jens Frøkjær
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lona L Christrup
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne E Olesen
- Mech-Sense, Department of Gastroenterology &Hepatology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.,Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Lin YJ, Kung YY, Kuo WJ, Niddam DM, Chou CC, Cheng CM, Yeh TC, Hsieh JC, Chiu JH. Effect of acupuncture 'dose' on modulation of the default mode network of the brain. Acupunct Med 2016; 34:425-432. [PMID: 27841974 PMCID: PMC5256125 DOI: 10.1136/acupmed-2016-011071] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2016] [Indexed: 01/05/2023]
Abstract
Objective Recent functional MRI (fMRI) studies show that brain activity, including the default mode network (DMN), can be modulated by acupuncture. Conventional means to enhance the neurophysiological ‘dose’ of acupuncture, including an increased number of needles and manual needle manipulation, are expected to enhance its physiological effects. The aim of this study was to compare the effects of both methods on brain activity. Methods 58 healthy volunteers were randomly assigned into four groups that received single needle acupuncture (SNA, n=15) or transcutaneous electrical nerve stimulation (TENS, n=13) as active controls, or enhanced acupuncture by way of three needle acupuncture (TNA, n=17) or SNA plus manual stimulation (SNA+MS, n=13). Treatment-associated sensations were evaluated using a visual analogue scale. Central responses were recorded before, during, and after treatment at LI4 on the left hand using resting state fMRI. Results TNA and SNA+MS induced DMN-insula activity and extensive DMN activity compared to SNA, despite comparable levels of de qi sensation. The TNA and SNA+MS groups exhibited a delayed and enhanced modulation of the DMN, which was not observed followed SNA and TENS. Furthermore, TNA increased precuneus activity and increased the DMN-related activity of the cuneus and left insula, while SNA+MS increased activity in the right insula. Conclusions The results showed that conventional methods to enhance the acupuncture dose induce different DMN modulatory effects. TNA induces the most extensive DMN modulation, compared with other methods. Conventional methods of enhancing the acupuncture dose could potentially be applied as a means of modulating brain activity.
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Affiliation(s)
- Yii-Jeng Lin
- Institute of Traditional Medicine, school of medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Ying Kung
- Institute of Traditional Medicine, school of medicine, National Yang-Ming University, Taipei, Taiwan.,Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Jui Kuo
- Institute of Neuroscience, school of medicine, National Yang-Ming University, Taipei, Taiwan.,Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - David M Niddam
- Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Brain Science, School of Medicine, National Yang-Ming, University, Taipei, Taiwan
| | - Chih-Che Chou
- Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chou-Ming Cheng
- Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Chen Yeh
- Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Brain Science, School of Medicine, National Yang-Ming, University, Taipei, Taiwan
| | - Jen-Chuen Hsieh
- Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Brain Science, School of Medicine, National Yang-Ming, University, Taipei, Taiwan
| | - Jen-Hwey Chiu
- Institute of Traditional Medicine, school of medicine, National Yang-Ming University, Taipei, Taiwan.,Division of General Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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Ichesco E, Puiu T, Hampson JP, Kairys AE, Clauw DJ, Harte SE, Peltier SJ, Harris RE, Schmidt-Wilcke T. Altered fMRI resting-state connectivity in individuals with fibromyalgia on acute pain stimulation. Eur J Pain 2016; 20:1079-89. [PMID: 26773435 DOI: 10.1002/ejp.832] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Fibromyalgia is a chronic widespread pain condition, with patients commonly reporting other symptoms such as sleep difficulties, memory complaints and fatigue. The use of magnetic resonance imaging (MRI) in fibromyalgia has allowed for the detection of neural abnormalities, with alterations in brain activation elicited by experimental pain and alterations in resting state connectivity related to clinical pain. METHODS In this study, we sought to monitor state changes in resting brain connectivity following experimental pressure pain in fibromyalgia patients and healthy controls. Twelve fibromyalgia patients and 15 healthy controls were studied by applying discrete pressure stimuli to the thumbnail bed during MRI. Resting-state functional MRI scanning was performed before and immediately following experimental pressure pain. We investigated changes in functional connectivity to the thalamus and the insular cortex. RESULTS Acute pressure pain increased insula connectivity to the anterior cingulate and the hippocampus. Additionally, we observed increased thalamic connectivity to the precuneus/posterior cingulate cortex, a known part of the default mode network, in patients but not in controls. This connectivity was correlated with changes in clinical pain. CONCLUSIONS These data reporting changes in resting-state brain activity following a noxious stimulus suggest that the acute painful stimuli may contribute to the alteration of the neural signature of chronic pain. WHAT DOES THIS STUDY/ADD?: In this study acute pain application shows an echo in functional connectivity and clinical pain changes in chronic pain.
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Affiliation(s)
- E Ichesco
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - T Puiu
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - J P Hampson
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - A E Kairys
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
- Department of Psychology, University of Colorado Denver, USA
| | - D J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - S E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - S J Peltier
- Functional MRI Laboratory, University of Michigan, Ann Arbor, USA
| | - R E Harris
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - T Schmidt-Wilcke
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, USA
- Department of Neurology, BG Universitätsklinik Bergmannsheil, Ruhr University Bochum, Germany
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43
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Affiliation(s)
- Robert M Bennett
- Professor of Medicine & Nursing, Oregon Health & Sciences University, Portland, OR 97239, USA
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44
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Yeo S, Rosen B, Bosch P, Noort MVD, Lim S. Gender differences in the neural response to acupuncture: clinical implications. Acupunct Med 2016; 34:364-372. [PMID: 27193838 DOI: 10.1136/acupmed-2015-011025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine gender differences and similarities in the psychophysical and brain responses to acupuncture at GB34, a point that is frequently used to treat motor function issues in Traditional Chinese Medicine. METHODS Functional MRI (fMRI) was used to measure brain activation in response to acupuncture at GB34 (on the right) in 19 healthy participants (9 male, 10 female). De qi sensations were rated to measure their psychophysical responses. RESULTS Overall de qi scores did not differ by gender, although females reported greater intensity of aching (p=0.04). Acupuncture activated the hippocampus, thalamus, globus pallidus, caudate body, claustrum, cingulate gyrus, and culmen in males, and the middle and inferior frontal gyrus, precuneus, postcentral gyrus, inferior parietal lobule, superior temporal gyrus, caudate body, insula, fusiform gyrus, cingulate gyrus, amygdala, and parahippocampal gyrus in females. The middle/medial frontal gyrus, middle temporal gyrus, thalamus, globus pallidus, caudate body, uvula, and cerebellar tonsil were activated when data from all subjects were combined. Relative to males, females exhibited greater brain activation in the right-sided postcentral gyrus, precentral gyrus, precuneus, postcentral gyrus, inferior parietal lobule, declive, middle occipital gyrus and parahippocampal gyrus. CONCLUSIONS The neural effects of GB34 acupuncture might differ between males and females because different brain structures were modulated in response to acupuncture. This potential gender effect should be taken into account in future clinical research. We also revealed that the caudate body was activated by GB34 acupuncture in both males and females and may represent a major target of GB34 acupuncture. TRIAL REGISTRATION NUMBER KMC IRB 0861-06.
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Affiliation(s)
- Sujung Yeo
- College of Korean Medicine, Sang Ji University, Wonju, Republic of Korea
| | - Bruce Rosen
- Department of Meridian & Acupoint, College of Korean Medicine, WHO Collaborating Center for Traditional Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, USA
| | - Peggy Bosch
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Maurits van den Noort
- Department of Meridian & Acupoint, College of Korean Medicine, WHO Collaborating Center for Traditional Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea Research Group of Pain and Neuroscience, Kyung Hee University, Seoul, Republic of Korea
| | - Sabina Lim
- Department of Meridian & Acupoint, College of Korean Medicine, WHO Collaborating Center for Traditional Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea Research Group of Pain and Neuroscience, Kyung Hee University, Seoul, Republic of Korea
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45
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46
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Silva FTG, Rêgo JTP, Raulino FR, Silva MR, Reynaud F, Egito EST, Dantas PMS. Transcranial direct current stimulation on the autonomic modulation and exercise time in individuals with spinal cord injury. A case report. Auton Neurosci 2015; 193:152-5. [PMID: 26329874 DOI: 10.1016/j.autneu.2015.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To report the effect of the transcranial direct current stimulation (tDCS) applied over the primary motor cortex (M1) of an individual, a sedentary male subject with complete chronic spinal cord injury at the T11-T12 levels. METHODS The individual underwent three experimental sessions: control, sham and anodal tDCS. Before, during and after exercise sessions, the following variables were recorded: heart rate variability, Rating of Perceived Exertion (RPE), power and glucose (this one only before and after the exercise). RESULTS The anodal tDCS provided greater exercise time and power, lower perceived exertion, greater reduction in glucose, and an increase in time to reach the threshold of heart rate variability. CONCLUSIONS tDCS caused an improvement in the exercise tolerance, probably due to the modulation of the autonomic nervous system and the pain, characterized by reduced RPE.
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Affiliation(s)
- Fabiana Tenório Gomes Silva
- Department of Physical Education, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Jeferson Tafarel Pereira Rêgo
- Department of Physical Education, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Francisco Rômulo Raulino
- Department of Physical Education, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Marília Rodrigues Silva
- Department of Physical Education, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Franceline Reynaud
- Department of Pharmacy, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Eryvaldo Sócrates Tabosa Egito
- Department of Pharmacy, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil.
| | - Paulo Moreira Silva Dantas
- Department of Physical Education, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
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Hansen TM, Olesen AE, Graversen C, Drewes AM, Frøkjaer JB. The Effect of Oral Morphine on Pain-Related Brain Activation - An Experimental Functional Magnetic Resonance Imaging Study. Basic Clin Pharmacol Toxicol 2015; 117:316-22. [PMID: 25924691 DOI: 10.1111/bcpt.12415] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/23/2015] [Indexed: 01/04/2023]
Abstract
Knowledge about cerebral mechanisms underlying pain perception and effect of analgesic drugs is important for developing methods for diagnosis and treatment of pain. The aim was to explore altered brain activation before and after morphine treatment using functional magnetic resonance imaging recorded during experimental painful heat stimulation. Functional magnetic resonance imaging data were recorded and analysed in 20 healthy volunteers (13 men and 7 women, 24.9 ± 2.6 years) in a randomized, double-blind, placebo-controlled, cross-over study. Painful stimulations were applied to the right forearm using a contact heat evoked potential stimulator (CHEPS) before and after treatment with 30 mg oral morphine and placebo. CHEPS stimulations before treatment induced activation in the anterior cingulate cortex, secondary somatosensory cortex/insula, thalamus and cerebellum (n = 16, p < 0.05). In response to morphine treatment, the spatial extent of these pain-specific areas decreased (n = 20). Reduced pain-induced activation was seen in the right insula, anterior cingulate cortex and inferior parietal cortex after morphine treatment compared to before treatment (n = 16, p < 0.05), and sensory ratings of pain perception were significantly reduced after morphine treatment (p = 0.02). No effect on pain-induced brain activation was seen after placebo treatment compared to before treatment (n = 12, p > 0.05). In conclusion, heat stimulation activated areas in the 'pain matrix' and a clinically relevant dose of orally administered morphine revealed significant changes in brain areas where opioidergic pathways are predominant. The method may be useful to investigate the mechanisms of analgesics.
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Affiliation(s)
- Tine Maria Hansen
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Estrup Olesen
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Carina Graversen
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Health Science and Technology, Center for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjaer
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Polymorphism in the µ-opioid receptor gene (OPRM1) modulates neural processing of physical pain, social rejection and error processing. Exp Brain Res 2015; 233:2517-26. [PMID: 26019010 DOI: 10.1007/s00221-015-4322-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
Abstract
Variations of the µ-opioid receptor gene OPRM1 have been shown to modulate pain perception with some evidence pointing towards a modulation of not only physical but also "psychological pain". In line with suggestions of a common neural network involved in the processing of physical pain and negative and distressing stimuli, like social rejection as a psychologically harmful event, we examined the influence of the A118G polymorphism on the neural processing of physical and non-physical pain. Using fMRI, we investigated a sample of 23 females with the more frequent AA genotype, and eight females with the relatively rare but more pain-sensitive AG genotype during electrical stimulation to the dorsum of the non-dominant hand. Non-physical pain was investigated using Cyberball, a virtual ball-tossing game, to induce experiences of non-self-dependent social rejection. A Go/NoGo task with an increased risk of self-dependent erroneous performance was used as a control task to investigate the effects of negative feedback as a more cognitive form of distress. Relative to A118G homozygous A-allele carriers, G-allele carriers showed significantly increased activation of the supplementary motor area/superior frontal gyrus and the precentral gyrus during electrical stimulation. Increased activation of the secondary sensorimotor cortex (SII) was found during social exclusion and during negative feedback. We demonstrate that brain regions particularly related to the somatosensory component of pain processing are modulated by variations in OPRM1. Influences were evident for both physical and psychological pain processing supporting the assumption of shared neural pathways.
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Desbordes G, Li A, Loggia ML, Kim J, Schalock PC, Lerner E, Tran TN, Ring J, Rosen BR, Kaptchuk TJ, Pfab F, Napadow V. Evoked itch perception is associated with changes in functional brain connectivity. NEUROIMAGE-CLINICAL 2014; 7:213-21. [PMID: 25610783 PMCID: PMC4300003 DOI: 10.1016/j.nicl.2014.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/28/2014] [Accepted: 12/01/2014] [Indexed: 02/07/2023]
Abstract
Chronic itch, a highly debilitating condition, has received relatively little attention in the neuroimaging literature. Recent studies suggest that brain regions supporting itch in chronic itch patients encompass sensorimotor and salience networks, and corticostriatal circuits involved in motor preparation for scratching. However, how these different brain areas interact with one another in the context of itch is still unknown. We acquired BOLD fMRI scans in 14 atopic dermatitis patients to investigate resting-state functional connectivity before and after allergen-induced itch exacerbated the clinical itch perception in these patients. A seed-based analysis revealed decreased functional connectivity from baseline resting state to the evoked-itch state between several itch-related brain regions, particularly the insular and cingulate cortices and basal ganglia, where decreased connectivity was significantly correlated with increased levels of perceived itch. In contrast, evoked itch increased connectivity between key nodes of the frontoparietal control network (superior parietal lobule and dorsolateral prefrontal cortex), where higher increase in connectivity was correlated with a lesser increase in perceived itch, suggesting that greater interaction between nodes of this executive attention network serves to limit itch sensation via enhanced top-down regulation. Overall, our results provide the first evidence of itch-dependent changes in functional connectivity across multiple brain regions. Atopic dermatitis patients were subjected to allergen-induced itch. Evoked itch reduced functional connectivity between itch-related brain regions. Evoked itch increased functional connectivity within frontoparietal control network. The above changes in functional connectivity correlated with perceived itch level. Itch sensation may be top-down regulated by frontoparietal control network.
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Key Words
- AD, atopic dermatitis
- ASL, arterial spin labeling
- Atopic dermatitis
- BA, Brodmann area
- BOLD, blood-oxygen-level dependent
- DMN, default mode network
- ECG, electrocardiography
- Eczema
- GLM, general linear model
- ITCH, evoked itch resting-state scan
- Insula
- L, left
- MNI, Montreal Neurological Institute
- MR, magnetic resonance
- PCC, posterior cingulate cortex
- PET, positron emission tomography
- PMC, premotor cortex
- Pruritus
- Putamen
- R, right
- REST, baseline resting-state scan
- S1/M1, primary sensorimotor cortex
- SCORAD, SCORing atopic dermatitis scale
- SPL, Superior parietal lobule
- VAS, visual analog scale
- aMCC, anterior mid-cingulate cortex
- dlPFC, dorsolateral prefrontal cortex
- fMRI, functional magnetic resonance imaging
- fcMRI, functional connectivity magnetic resonance imaging
- pMCC, posterior mid-cingulate cortex
- vlPFC, ventrolateral prefrontal cortex.
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Affiliation(s)
- Gaëlle Desbordes
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ang Li
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco L Loggia
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jieun Kim
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter C Schalock
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ethan Lerner
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thanh N Tran
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johannes Ring
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
| | - Bruce R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ted J Kaptchuk
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Florian Pfab
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ; Department of Dermatology and Allergy, Technische Universität München, Munich, Germany ; Department of Prevention and Sports Medicine, Technische Universität München, Munich, Germany
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ; Department of Radiology, Logan College of Chiropractic, Chesterfield, MO, USA ; Department of Biomedical Engineering, Kyunghee University, Yongin, Korea
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Flodin P, Martinsen S, Löfgren M, Bileviciute-Ljungar I, Kosek E, Fransson P. Fibromyalgia is associated with decreased connectivity between pain- and sensorimotor brain areas. Brain Connect 2014; 4:587-94. [PMID: 24998297 DOI: 10.1089/brain.2014.0274] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Fibromyalgia (FM) is a syndrome characterized by chronic pain without known peripheral causes. Previously, we have reported dysfunctional pain inhibitory mechanisms for FM patients during pain administration. In this study we employed a seed correlation analysis, independent component analysis (ICA), and an analysis of fractional amplitude of low frequency fluctuations (fALFF) to study differences between a cohort of female FM patients and an age- and sex-matched healthy control group during a resting-state condition. FM patients showed decreased connectivity between thalamus and premotor areas, between the right insula and primary sensorimotor areas, and between supramarginal and prefrontal areas. Individual sensitivity to painful pressure was associated with increased connectivity between pain-related regions (e.g., insula and thalamus) and midline regions of the default mode network (including posterior cingulate cortex and medial prefrontal cortex) among patients and controls. However, neither ICA nor fALFF revealed any group differences. Our findings suggest that abnormal connectivity patterns between pain-related regions and the remaining brain during rest reflect an impaired central mechanism of pain modulation in FM. Weaker coupling between pain regions and prefrontal- and sensorimotor areas might indicate a less efficient system level control of pain circuits. Moreover, our results show that multiple, complementary analytical approaches are valuable for obtaining a more comprehensive characterization of deviant resting-state activity. In conclusion, our findings show that FM primarily is associated with decreased connectivity, for example, between several pain-related areas and sensorimotor regions, which could reflect a deficiency in pain regulation.
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Affiliation(s)
- Pär Flodin
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
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